Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • flank pain
  • fever
  • lower urinary tract symptoms
  • neurologic disease (e.g., spinal cord injury, multiple sclerosis)
  • distended abdomen/palpable bladder
  • inability to urinate
  • enlarged or hard nodular prostate on rectal examination
  • costovertebral angle tenderness

Other diagnostic factors

  • hematuria
  • increasing age
  • meatal narrowing
  • pelvic or abdominal malignancy
  • previous urethral instrumentation
  • UTI in a child
  • pelvic mass on internal examination
  • weight loss and lymphadenopathy
  • recurrent UTIs
  • urinary incontinence

Risk factors

  • benign prostatic hyperplasia (BPH)
  • constipation
  • medication (anticholinergic agents, narcotic analgesia, alpha receptor agonists)
  • urolithiasis (ureteric calculi)
  • spinal cord injury, Parkinson disease, or multiple sclerosis
  • malignancy
  • pregnancy
  • hematuria
  • posterior urethral valves
  • bladder hernia
  • cystocele
  • iatrogenic injury
  • urethral instrumentation
  • retroperitoneal fibrosis
  • meatal stenosis

Diagnostic investigations

1st investigations to order

  • urinary dipstick
  • renal ultrasound
  • serum BUN and creatinine
  • CBC
  • CT pyelogram
  • intravenous pyelogram (excretory urography)
Full details

Investigations to consider

  • prostate specific antigen
  • tumor markers (e.g., serum CEA, CA125)
  • CT scan abdomen and pelvis
  • nuclear renography (triple renal/MAG3 scan)
  • voiding cystourethrogram
  • bladder ultrasound
  • magnetic resonance urography
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Urologist

Christus Good Shepherd

Longview

TX

Disclosures

AJC declares that she has no competing interests.

Peer reviewers VIEW ALL

Private Practice Urologist

Asheville

NC

Disclosures

BC declares that he has no competing interests.

Private Practice Urologist

Miami

FL

Disclosures

YS declares that he has no competing interests.

Lecturer in Uro-oncology and Consultant Urological Surgeon

Department of Urology

Addenbrooke's Hospital

Cambridge

UK

Disclosures

VG declares that he has no competing interests.

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